Name:________________________________     Social Security #:______________________

------  1.  I agree not to publish, disclose or utilize any confidential information HR Associates Personnel or any clients of HR Associates Personnel where I am sent to work, and I will assign and disclose to HR Associates Personnel client any invention perfected or conceived during my hours of work for such client and will sign all papers necessary to enable HR Associates Personnel client to obtain a patent on these inventions and to obtain copyrights.

------  2.  I understand that I am required to work a certain amount of hours before I can be hired by a HR Associates Personnel client.  I understand that I cannot return to that client on my own for a period of 6 months after the ending of my employment.  This applies only to clients that I have worked for through HR Associates Personnel.

------  3.  I will not solicit or accept any employment with the clients of HR Associates Personnel without prior written authorization from HR Associates Personnel.

------  4.  I understand that if I accepted an assignment through HR Associates Personnel, I am required to report to work everyday on time and work the scheduled hours described to me.  

------  5.  Your employment of me may be terminated by you at any time without any liabilities to me accept for wages and salary I have earned by the date of such termination.

------  6.  I understand that if I do not report to an assignment as scheduled, or quit the assignment for any reason without giving the minimum required 24 hour notice to HR Associates Personnel, my pay rate will be reduced to the legal minimum wage for the last full week worked.  I also understand that I will no longer be eligible for placement.

------  7.  I understand that if I am released from an assignment due to an attendance issue, HR Associates Personnel will terminate my application and I will no longer be eligible for future placements.

------  8.  Any criminal acts towards HR Associates Personnel and/or clients will results in my immediate discharge.

------  9.  I understand that if I refuse (2) assignments my application will be discharged.

------ 10.  I understand that I MUST notify HR Associates Personnel immediately when an injury occurs no matter how minor or how major the injury is prior to medical treatment.  If I do not, it may result in a worker’s compensation claim being denied ultimately, putting all responsibility of payment (medical bills) on myself.  This also includes testing positive for a post-accident drug screen.  My application will automatically be discharged and my claim will be denied.

------ 11. I agree, if employed by you, that if ever I make claims against you for personal injuries upon your request I shall submit to a drug screen and examination by physicians of your selection.

 ------ 12.  I understand that if I am required to take a pre-employment drug screen and fail to show or test positive I will no longer be eligible for employment with HR Associates Personnel Service or any of their clients.

Do you have any limitations that would prevent you from lifting, twisting, bending, stooping, kneeling, and squatting during your shift?  If yes, please list them below.



Signature: ___________________________________________________Date:_______________________________

We will not use the information on this application to discriminate against any individual with respect to his/her compensation, terms, conditions, or privileges of employment because of race, color, religion, sex, age, national origin, or physical handicap.